Issues in Mental Health Nursing, 35:805–808, 2014 Copyright © 2014 Informa Healthcare USA, Inc. ISSN: 0161-2840 print / 1096-4673 online DOI: 10.3109/01612840.2014.908442
CULTURAL COMPETENCE COLUMN
What’s So Funny? And is that Bad or Good? Jacquelyn H. Flaskerud, RN, PhD, FAAN University of California—Los Angeles, School of Nursing, Los Angeles, California, USA
Edited by Jacquelyn H. Flaskerud, RN, PhD, FAAN University of California—Los Angeles, School of Nursing, Los Angeles, California, USA Have you ever been in a movie theatre or at a live theatre performance when in an emotional, sad part of the story you noticed, with irritation, that the people around you were giggling, snickering, laughing? And you whispered to your companion that these people were especially insensitive? The first time I recall seemingly inappropriate behavior like this (and reactions of others to it) was at the death of my grandmother. I was 16 years old and devastated at losing her. My two best girlfriends came to the visitation at the funeral home to offer me their condolences, certainly directed to do so by their mothers, and spent their time in a corner giggling. I was upset and my very large extended family was quite critical of their behavior; my dad suggested to me that they were nervous. What reasons are given for our laughter? My dad’s explanation would fit into those that say that laughter is a release of tension or a defense mechanism, in this case against the anxiety experienced by the grief of a friend and not knowing how to respond. There are many explanations of humor and several attempts have been made to explain the scientific basis for ‘funny.’ Some of the dissertations on humor came from the early philosophers, such as Plato and Aristotle (and later Hobbes), who believed that humor was coarse and common; something to be avoided by well-bred and serious observers of life. Others came from psychology, social sciences, and anthropology. And still others are focused on neurocognitive science. There are differences in humor, laughter and what makes things funny, and scholars throughout time have tried to analyze and distinguish these variations. Many explanations have a psychological, social, and/or philosophical origin; however, some would say that humor has a pure biological origin, while its social functions arose later. Many of these interpretations have negative connotations Address correspondence to Jacquelyn H. Flaskerud, School of Nursing, University of California, 700 Tiverton Ave, Factor Building, Box 951702, Los Angeles, CA 90095–1702. E-mail: [email protected]
associated with them, or at least human error that wants/needs correction. In a lecture I attended some time ago, the professor described four theories of humor. The first, which he attributed to Freud, was a theory of ‘repressed aggression’: that jokes are barely disguised acts of aggression. One cannot express aggression directly, as it is prohibited in polite society, so these desires become sublimated by telling ‘jokes’ (Billig, 2002). That rang a bell! During my career, I had observed colleagues saying something unkind about another co-worker and then laughing, as if they were joking. But I also noticed the hurt look on the face of the person to whom the joke was directed. More recently, while listening to an interview, a British reporter remarked on the intellectual caliber of our elected officials in the USA. He commented that Jefferson spoke six foreign languages and then compared him with a current popular politician whom he disparaged and said that he doubted that she had even seen a movie with foreign subtitles. I laughed and thought it a clever comment. Then I thought, ‘Well, that was kind of mean.’ Was I thereby excusing myself for finding it funny? According to Freud, if people are asked why they are laughing at a joke, they will tend to point to the cleverness of it (Billig, 2002). We like to think that the cleverness of the joke is the source of our enjoyment. From this, Freud argued that self-deceit lies at the root of much enjoyment of humor. We want to believe that our humor is moral like ourselves – that we are innocently enjoying good jokes, which are ‘just jokes.’ However, the sound of our laughter has an aggressive edge that permits momentary pleasure in feeling cruel (Billig, 2002). This explanation of the use of humor as an act of expressing repressed aggression makes it appear as a function that is programmed culturally, giving it a social role– a way to express aggressive thoughts which are forbidden in well-bred society. Another theory of humor presented in the lecture I attended seemed to bear a relationship to that of the expression of aggression. This one emphasized superiority and was attributed to Thomas Hobbes (1640) – humor comes from putting other people down; ridicule or demeaning others is one of humor’s primary uses. The example given above of the reporter disparaging a politician’s intellect would seem to fit this theory as well as the
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aggression theory. The ‘superiority theory’ is at work when we laugh at jokes that focus on someone else’s mistakes, stupidity or misfortune – consider the genre of Blonde jokes. In these types of jokes, people appear stupid because they have misunderstood an obvious situation, made a stupid mistake, been the hapless victim of unfortunate circumstance, or have been made to look stupid by someone else. These jokes make us feel superior to other people. The superiority theory explains why we laugh when people slip on a banana peel or have a custard pie slapped into their face. In his discourse on laughter, Hobbes (1640) asserted that men laugh at the mischance and indecencies of others. His most often referred to remark about laughter is that it proceeds from the conception of our own eminence in comparison with another man’s infirmities or absurdity, or with a past infirmity of our own that no longer exists in the present. Tension release (or relief) describes the third theory of humor, but is actually more focused on laughter. There is a difference between laughter and humor. Laughter is a bodily function that comes from a combination of physical processes. Laughter results from many different events: observing something amusing, physical stimulation (tickling), or excitement, as when a baby laughs upon being tossed in the air. Humor is an involuntary state of mental amusement that comes about via observation of action, speech, writing, or introspection (Meyer, 2000). The important distinction between the two is that humor is much more exclusive, requiring amusement. Being tickled may cause a person to laugh, but that does not mean they are amused. The ‘relief (release) theory’ discusses the essential structures and psychological processes that make us laugh. This theory proposes that laughter comes from the release of mental tension and expectations. Relief theory maintains that laughter is a homeostatic mechanism, by which psychological tension is reduced (Meyer, 2000). Humor may serve to facilitate relief of the tension caused by one’s fears or anxieties. Laughter, according to relief theory, results from this release of nervous energy (Meyer, 2000). This explanation is close to that of my dad’s explaining the reaction of my girlfriends to their anxiety at expressing sympathy to me at my grandmother’s funeral or the people in a movie theatre who laugh during a sad or tense part of a story. It may be noted that the first three theories described above provide psychological explanations for humor and laughter, positions with which we, as mental health professionals in Western society, are very comfortable. They also present a negative side to humor – aggression, superiority, and tension release. The fourth, and currently popular theory of humor, involves the concept of incongruity. The ‘incongruity theory’ states that humor is perceived at the moment of realization of incongruity between what we thought was involved in a certain situation and the real outcome in relation to that concept (Smuts, 2009). The idea is that we laugh at things that surprise us because they seem out of place. Many jokes are funny because they involve ideas that run against our expectations. But there is more to this theory than simple forms of incongruity. Since the main point of the theory is not the incongruity itself but its realization and
resolution, it is often called the ‘incongruity-resolution theory’ (Smuts, 2009). People laugh at a situation not just because it is incongruous, but because they realize that the incongruity can be resolved or interpreted in a different way. This theory seems to make sense when you consider how a punch-line works: first, a joke sets up a situation; then, a cleverly constructed punchline causes the listener to reconsider what he has just heard. In many jokes, there is an apparent incongruity between the set-up and the punch line, for example: Two fish are in a tank. One turns to the other and says: ‘Do you know how to drive this?’ We resolve the incongruity caused by the punch-line, and the accompanying feeling of sudden surprise makes us laugh. There are two main criticisms to this theory: not all incongruities are necessarily funny, for example parental cruelty, a breach of contract, or an out-of-tune instrument. An additional criticism of the incongruity-resolution theory is that not all reinterpreted incongruities are funny (Smuts, 2009). When a nurse encounters a strange set of symptoms that do not seem to belong together, and her team eventually diagnose the reason (resolves the incongruity), nobody laughs. One other theory that came to prominence in the late 1990s, called the ‘benign violation theory,’ is based on the work of Thomas Veatch (1998) and is currently being further developed by others. This theory describes humor as something that occurs when someone perceives a situation as a violation and simultaneously realizes that the situation is also benign. Laughter is used to communicate that the violation is benign. We laugh when something is violated – like morals, social codes, linguistic norms, or personal dignity – but the violation is not threatening. However, there are many violations that are benign but not humorous; for instance, driving a couple of miles per hour over the speed limit or without a seat belt. Both the incongruity-resolution theory and benign violation theory rely on psychological underpinnings for our sense of humor and might be seen as attempts to correct misperceptions. With the recent advances of research in neuroscience comes a new theory of humor. Hurley, Dennett and Adams (2011) – a cognitive scientist, a philosopher, and a psychologist – recently published a book Inside Jokes: Using Humor to ReverseEngineer the Mind, in which they set out to discover a ‘grand unified theory’ of humor. What Hurley and colleagues (2011) offer is an evolutionary and cognitive perspective to the development of humor as the brain’s way of telling us that we committed too soon to one interpretation of reality or to one assumption about the future (Hurley et al., 2011, p. 97). Our emotional and cognitive capacity for humor gives us a chance to figure out where we have made such mistakes without judging ourselves harshly, and in fact, is the brain’s way of rewarding us with amusement at our own previously held position. Humor’s role is to eliminate the deceptive idea as fast as possible before it can cause any damage, or further squander the brain’s resources. It also provides the opportunity to change one’s mind – learn – without penalty; this process allows us to learn incrementally and revise constantly – in actuality, a problem-solving process.
CULTURAL COMPETENCE
Evolution has designed the mechanism of humor and the feeling of enjoyment that bribes us to continue generating assumptions until we get it right. In a review of this theory, Greengross and Mankoff (2012) note that Inside Jokes. . . uses jokes primarily as examples to verify their theory, and the theory is indeed an excellent one for explaining jokes. Jokes are very good material for the theory because they work, for the most part, by creating a belief that we accept unconsciously but we then have to reconsider when the punch-line does not fit the narrative of the set-up. However, once the theory moves outside of the realm of set-up and punchline jokes, the explanation becomes strained. They go on to say that as anyone can observe, humor usually involves minor error correction (Greengross & Mankoff, 2012). To deal with more serious mistakes, we use other cognitive mechanisms and we do not find them funny. Humor involves incongruities that are mostly trivial, or even fictional (e.g. fables), so it is not clear how important this error correcting mechanism was to our evolved cognition. Additionally, it is easy to demonstrate that correcting mistaken ideas is not always the basis of humor: people can laugh at the same jokes over and over again; obviously this has nothing to do with learning or correcting previous incorrect perceptions (Greengross & Mankoff, 2012). Greengross and Mankoff (2012) detail further problems for the theory: there are instances where our first perceptions or beliefs are shown to be incorrect where no humor results. A trick question on an exam may elicit an incorrect answer; when we are told that we were wrong, we do not consider it to be funny. Additionally, they note that good humor usually produces laughter. Yet we laugh at many situations that are not on the face of it, humorous: we laugh when we are tickled; children laugh while at play. Humor is also subjective and has a social aspect – consider inside jokes or the fact that different people find different situations to be humorous. Or that something we might not find to be funny when we are alone will cause us to laugh when we are in a group. The theories of humor presented thus far focus on negative aspects of humor, or at best humor as a mechanism to correct mistaken perceptions. What about the positive aspects of humor? Is there any good to be found in it? The theory by Hurley and colleagues (2011) acknowledges that humor is pleasurable – an evolutionary adaptation that makes it possible for us to admit error and revise our perceptions. But humor is more than that – it is desirable, often sharable, surprising, playful, nonsensical, and insightful. During my career, I had the privilege of having an office down the hall from Norman Cousins, who believed that humor was therapeutic. In his book Anatomy of an Illness, Cousins (1979) recounts how he used humor and laughter to regenerate himself from a painful, inflammatory collagen disease. He asked, if negative emotions produce negative chemical changes in the body, then wouldn’t positive emotions produce positive chemical changes? Cousins identified love, hope, faith, laughter, confidence, and the will to live, as having therapeutic value (Cousins, 1979, pp. 34–35). Working with his physician,
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he began implementing a systematic program that included comedy shows and films – Candid Camera, the Marx Brothers – and humor books. He made the discovery that 10 minutes of ‘genuine belly laughter had an anesthetic effect’ that would give him ‘at least two hours of pain-free sleep’ (Cousins, 1979, p. 39). To test his theory, hospital staff took laboratory measures of sedimentation rates immediately after and several hours after each laughter episode, and found that there was a 5-point drop that held and was cumulative (Cousins, 1979, p. 40). Others have pursued this same line of thinking. In 1989, using healthy participants, Berk and colleagues tested the proposal that positive emotional experiences would act as modifiers of neuroendocrine and stress hormones involved in the classical stress response. To detect these changes, the authors studied 10 healthy male participants during a mirthful laughter experience. Five experimental participants viewed a 60-minute humor video and five control participants did not. Serial blood samples were measured for several neuroendocrine and stress hormones. The authors reported that the mirthful laughter experience appeared to reduce serum levels of cortisol, dopac, epinephrine, and growth hormone. They concluded that these biochemical changes have implications for the reversal of the neuroendocrine and classical stress hormone response (Berk et al., 1989). Several reports have demonstrated the use of humor to reduce stress, relieve pain, or as an adjuvant therapy to improve overall quality of life (Cancer Treatment Centers of America, 2013; Christie & Moore, 2005). According to these studies, laughter appears to improve mood, lessen anxiety, reduce psychological measures of stress, and reduce perception of pain. The mechanisms that underlie these effects may involve release of psychological tension, which could act as a buffer of stressful events on affect. However, it is also possible that physiological factors may be involved. For example, laughter can lead to changes in heart rate, skin temperature, blood pressure, pulmonary ventilation, skeletal muscle activity, and brain activity, which may improve overall wellbeing. Psychoneuroimmunology research suggests that, in addition to its established psychological benefits, humor may have physiological effects on immune functioning. Laughter may improve immune function by blocking the production of stress hormones, such as cortisol, and by increasing the release of immune-enhancers, such as beta-endorphin (Cancer Treatment Centers of America, 2013; Christie & Moore, 2005). Nurses have made important contributions to the study of the therapeutic effects of laughter (Christie & Moore, 2005). Bennett, Zeller, Rosenberg, and McCann (2003) have studied the effects of laughter on stress and natural killer (NK) cell activity. In a survey of patients with cancer in the rural Midwest, they noted that humor was one of the most frequently used complementary therapies. To determine the effect of laughter on self-reported stress and NK cell activity, they conducted a randomized, pre-test/post-test comparison group study in a nurse-managed community health clinic in a mid-sized Midwestern city. Participants were 33 healthy adult women. Those in the experimental group viewed a humorous video, while participants in the
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distraction control group viewed a tourism video. Measurements included self-reported stress and arousal (Stress Arousal Check List), mirthful laughter (Humor Response Scale), and immune function (chromium release NK cell cytotoxicity assay). The investigators found that stress decreased significantly for subjects in the humor group, when compared with those in the distraction group (Bennett et al., 2003). The amount of mirthful laughter had a significant correlation with post-intervention stress measures for persons in the humor group. Participants who scored >25 on the humor response scale had a significant increase in immune function post-intervention, and when compared with participants with lower scores. Humor response scale scores correlated with changes in NK cell activity. The investigators concluded that laughter may reduce stress and improve NK cell activity. As low NK cell activity is linked to decreased disease resistance and increased morbidity in persons with cancer and HIV disease, laughter may be a useful cognitive-behavioral intervention (Bennett et al., 2003). Other nurses have investigated the effects of laughter on postprandial blood glucose (Hayashi et al., 2003). These researchers conducted a 2-day experiment with 19 patients with type 2 diabetes not receiving insulin therapy and five healthy subjects. On both experimental days, the participants consumed the same 500 kcal meal. On the first day, they attended a monotonous lecture (40 min) without humorous content. On the second day, they attended a cross-talk Japanese comedy show. The investigators found that patients with diabetes who were exposed to a comedy show demonstrated a significant suppression of the increase in 2-h post-prandial blood glucose, suggesting that laughter ameliorates the post-prandial glucose excursion in the presence of insufficient insulin action (Hayashi et al., 2003). They concluded that this favorable effect of laughter may include the acceleration of glucose utilization by the muscle motion during the comedy show. However, it is possible also that the positive emotions, such as laughter, acted on the neuroendocrine system and suppressed the elevation of blood glucose level (Hayashi et al., 2003). The question in the title of this column asked whether humor should be viewed negatively or positively. In a theoretical sense, it has been proposed to reflect negative emotions such as aggression and superiority, tension release, incongruence, benign violations of norms, and an evolutionary development to correct errors in perception. When we think of why people laugh, many of these explanations gain credence. However, in clinical practice and research, humor used as a means to evoke laughter, has been shown to have therapeutic effects. As noted,
there is a difference between humor and laughter. Many studies describe the laughter of their participants as ‘mirthful,’ meaning joyful or happy, perhaps as distinguished from nervous laughter or demeaning laughter, and so forth. It might be asked what kind of humor was used in the research reported above to elicit laughter. Maybe when introducing humor as a therapy, we should be careful that it is not mean-spirited. Or maybe it does not matter – that laughter itself is the goal. Regardless, there seems to be a promising role for humor and laughter as an adjuvant therapy and one that nurses might be particularly able to employ in their patient care. A final caveat – there is the definite probability that humor is culture-specific and what is funny to one group may not be considered funny by others. Declaration of Interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper. REFERENCES Bennett, M. P., Zeller, J. M., Rosenberg, L., & McCann, J. (2003). The effect of mirthful laughter on stress and Natural Killer cell activity. Alternative Therapies in Health and Medicine, 9(2), 38–45. Berk, L. S., Tan, S. A., Fry, W. F., Napier, B. J., Lee, J. W., Hubbard, R. W., et al. (1989). Neuroendocrine and stress hormone changes during mirthful laughter. American Journal of the Medical Sciences, 298(6), 390– 396. Billig, M. (2002). Freud and the language of humour. The Psychologist, 15(9), 452–456. Cancer Treatment Centers of America. (2013). Laughter therapy. Retrieved from http://www.cancercenter.com/treatments/laughter-therapy/. Christie, W. & Moore, C. (2005). The impact of humor on patients with cancer. Clinical Journal of Oncology Nursing, 9(2), 211–218. Cousins, N. (1979). Anatomy of an illness as perceived by the patient. New York: Bantam Books. Greengross, G. & Mankoff, R. (2012). Inside ‘Inside Jokes’: The hidden side of humor. Evolutionary Psychology, 10(3), 443–456. Hayashi, K., Hayashi, T., Iwanaga, S., Kawai, K., Ishii, H., Shoji, S., et al. (2003). Laughter lowered the increase in postprandial blood glucose. Diabetes Care, 26(5), 1651–1652. Hobbes, T. (1640). Of the passions of the mind. Elements of Law, Natural and Politic, Chapter IX, No. 13, Laughter. Retrieved from http://www.thomashobbes.com/works/elements/10.html. Hurley, M. M., Dennett, D. C., & Adams Jr., R. B. (2011). Inside Jokes: Using Humor to Reverse-Engineer the Mind. Boston: Massachusetts Institute of Technology Press. Meyer, J. C. (2000). Humour as a double-edged sword: Four functions of humour in communication. Communication Theory, 10, 310–331. Smuts, A. (2009). Humor. The Internet Encyclopedia of Philosophy, Retrieved from http://www.iep.utm.edu/. Veatch, T. C. (1998). A theory of humor. Humor – International Journal of Humor Research, 11, 163–215.
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CULTURAL COMPETENCE COLUMN
What’s So Funny? And is that Bad or Good? Jacquelyn H. Flaskerud, RN, PhD, FAAN University of California—Los Angeles, School of Nursing, Los Angeles, California, USA
Edited by Jacquelyn H. Flaskerud, RN, PhD, FAAN University of California—Los Angeles, School of Nursing, Los Angeles, California, USA Have you ever been in a movie theatre or at a live theatre performance when in an emotional, sad part of the story you noticed, with irritation, that the people around you were giggling, snickering, laughing? And you whispered to your companion that these people were especially insensitive? The first time I recall seemingly inappropriate behavior like this (and reactions of others to it) was at the death of my grandmother. I was 16 years old and devastated at losing her. My two best girlfriends came to the visitation at the funeral home to offer me their condolences, certainly directed to do so by their mothers, and spent their time in a corner giggling. I was upset and my very large extended family was quite critical of their behavior; my dad suggested to me that they were nervous. What reasons are given for our laughter? My dad’s explanation would fit into those that say that laughter is a release of tension or a defense mechanism, in this case against the anxiety experienced by the grief of a friend and not knowing how to respond. There are many explanations of humor and several attempts have been made to explain the scientific basis for ‘funny.’ Some of the dissertations on humor came from the early philosophers, such as Plato and Aristotle (and later Hobbes), who believed that humor was coarse and common; something to be avoided by well-bred and serious observers of life. Others came from psychology, social sciences, and anthropology. And still others are focused on neurocognitive science. There are differences in humor, laughter and what makes things funny, and scholars throughout time have tried to analyze and distinguish these variations. Many explanations have a psychological, social, and/or philosophical origin; however, some would say that humor has a pure biological origin, while its social functions arose later. Many of these interpretations have negative connotations Address correspondence to Jacquelyn H. Flaskerud, School of Nursing, University of California, 700 Tiverton Ave, Factor Building, Box 951702, Los Angeles, CA 90095–1702. E-mail: [email protected]
associated with them, or at least human error that wants/needs correction. In a lecture I attended some time ago, the professor described four theories of humor. The first, which he attributed to Freud, was a theory of ‘repressed aggression’: that jokes are barely disguised acts of aggression. One cannot express aggression directly, as it is prohibited in polite society, so these desires become sublimated by telling ‘jokes’ (Billig, 2002). That rang a bell! During my career, I had observed colleagues saying something unkind about another co-worker and then laughing, as if they were joking. But I also noticed the hurt look on the face of the person to whom the joke was directed. More recently, while listening to an interview, a British reporter remarked on the intellectual caliber of our elected officials in the USA. He commented that Jefferson spoke six foreign languages and then compared him with a current popular politician whom he disparaged and said that he doubted that she had even seen a movie with foreign subtitles. I laughed and thought it a clever comment. Then I thought, ‘Well, that was kind of mean.’ Was I thereby excusing myself for finding it funny? According to Freud, if people are asked why they are laughing at a joke, they will tend to point to the cleverness of it (Billig, 2002). We like to think that the cleverness of the joke is the source of our enjoyment. From this, Freud argued that self-deceit lies at the root of much enjoyment of humor. We want to believe that our humor is moral like ourselves – that we are innocently enjoying good jokes, which are ‘just jokes.’ However, the sound of our laughter has an aggressive edge that permits momentary pleasure in feeling cruel (Billig, 2002). This explanation of the use of humor as an act of expressing repressed aggression makes it appear as a function that is programmed culturally, giving it a social role– a way to express aggressive thoughts which are forbidden in well-bred society. Another theory of humor presented in the lecture I attended seemed to bear a relationship to that of the expression of aggression. This one emphasized superiority and was attributed to Thomas Hobbes (1640) – humor comes from putting other people down; ridicule or demeaning others is one of humor’s primary uses. The example given above of the reporter disparaging a politician’s intellect would seem to fit this theory as well as the
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aggression theory. The ‘superiority theory’ is at work when we laugh at jokes that focus on someone else’s mistakes, stupidity or misfortune – consider the genre of Blonde jokes. In these types of jokes, people appear stupid because they have misunderstood an obvious situation, made a stupid mistake, been the hapless victim of unfortunate circumstance, or have been made to look stupid by someone else. These jokes make us feel superior to other people. The superiority theory explains why we laugh when people slip on a banana peel or have a custard pie slapped into their face. In his discourse on laughter, Hobbes (1640) asserted that men laugh at the mischance and indecencies of others. His most often referred to remark about laughter is that it proceeds from the conception of our own eminence in comparison with another man’s infirmities or absurdity, or with a past infirmity of our own that no longer exists in the present. Tension release (or relief) describes the third theory of humor, but is actually more focused on laughter. There is a difference between laughter and humor. Laughter is a bodily function that comes from a combination of physical processes. Laughter results from many different events: observing something amusing, physical stimulation (tickling), or excitement, as when a baby laughs upon being tossed in the air. Humor is an involuntary state of mental amusement that comes about via observation of action, speech, writing, or introspection (Meyer, 2000). The important distinction between the two is that humor is much more exclusive, requiring amusement. Being tickled may cause a person to laugh, but that does not mean they are amused. The ‘relief (release) theory’ discusses the essential structures and psychological processes that make us laugh. This theory proposes that laughter comes from the release of mental tension and expectations. Relief theory maintains that laughter is a homeostatic mechanism, by which psychological tension is reduced (Meyer, 2000). Humor may serve to facilitate relief of the tension caused by one’s fears or anxieties. Laughter, according to relief theory, results from this release of nervous energy (Meyer, 2000). This explanation is close to that of my dad’s explaining the reaction of my girlfriends to their anxiety at expressing sympathy to me at my grandmother’s funeral or the people in a movie theatre who laugh during a sad or tense part of a story. It may be noted that the first three theories described above provide psychological explanations for humor and laughter, positions with which we, as mental health professionals in Western society, are very comfortable. They also present a negative side to humor – aggression, superiority, and tension release. The fourth, and currently popular theory of humor, involves the concept of incongruity. The ‘incongruity theory’ states that humor is perceived at the moment of realization of incongruity between what we thought was involved in a certain situation and the real outcome in relation to that concept (Smuts, 2009). The idea is that we laugh at things that surprise us because they seem out of place. Many jokes are funny because they involve ideas that run against our expectations. But there is more to this theory than simple forms of incongruity. Since the main point of the theory is not the incongruity itself but its realization and
resolution, it is often called the ‘incongruity-resolution theory’ (Smuts, 2009). People laugh at a situation not just because it is incongruous, but because they realize that the incongruity can be resolved or interpreted in a different way. This theory seems to make sense when you consider how a punch-line works: first, a joke sets up a situation; then, a cleverly constructed punchline causes the listener to reconsider what he has just heard. In many jokes, there is an apparent incongruity between the set-up and the punch line, for example: Two fish are in a tank. One turns to the other and says: ‘Do you know how to drive this?’ We resolve the incongruity caused by the punch-line, and the accompanying feeling of sudden surprise makes us laugh. There are two main criticisms to this theory: not all incongruities are necessarily funny, for example parental cruelty, a breach of contract, or an out-of-tune instrument. An additional criticism of the incongruity-resolution theory is that not all reinterpreted incongruities are funny (Smuts, 2009). When a nurse encounters a strange set of symptoms that do not seem to belong together, and her team eventually diagnose the reason (resolves the incongruity), nobody laughs. One other theory that came to prominence in the late 1990s, called the ‘benign violation theory,’ is based on the work of Thomas Veatch (1998) and is currently being further developed by others. This theory describes humor as something that occurs when someone perceives a situation as a violation and simultaneously realizes that the situation is also benign. Laughter is used to communicate that the violation is benign. We laugh when something is violated – like morals, social codes, linguistic norms, or personal dignity – but the violation is not threatening. However, there are many violations that are benign but not humorous; for instance, driving a couple of miles per hour over the speed limit or without a seat belt. Both the incongruity-resolution theory and benign violation theory rely on psychological underpinnings for our sense of humor and might be seen as attempts to correct misperceptions. With the recent advances of research in neuroscience comes a new theory of humor. Hurley, Dennett and Adams (2011) – a cognitive scientist, a philosopher, and a psychologist – recently published a book Inside Jokes: Using Humor to ReverseEngineer the Mind, in which they set out to discover a ‘grand unified theory’ of humor. What Hurley and colleagues (2011) offer is an evolutionary and cognitive perspective to the development of humor as the brain’s way of telling us that we committed too soon to one interpretation of reality or to one assumption about the future (Hurley et al., 2011, p. 97). Our emotional and cognitive capacity for humor gives us a chance to figure out where we have made such mistakes without judging ourselves harshly, and in fact, is the brain’s way of rewarding us with amusement at our own previously held position. Humor’s role is to eliminate the deceptive idea as fast as possible before it can cause any damage, or further squander the brain’s resources. It also provides the opportunity to change one’s mind – learn – without penalty; this process allows us to learn incrementally and revise constantly – in actuality, a problem-solving process.
CULTURAL COMPETENCE
Evolution has designed the mechanism of humor and the feeling of enjoyment that bribes us to continue generating assumptions until we get it right. In a review of this theory, Greengross and Mankoff (2012) note that Inside Jokes. . . uses jokes primarily as examples to verify their theory, and the theory is indeed an excellent one for explaining jokes. Jokes are very good material for the theory because they work, for the most part, by creating a belief that we accept unconsciously but we then have to reconsider when the punch-line does not fit the narrative of the set-up. However, once the theory moves outside of the realm of set-up and punchline jokes, the explanation becomes strained. They go on to say that as anyone can observe, humor usually involves minor error correction (Greengross & Mankoff, 2012). To deal with more serious mistakes, we use other cognitive mechanisms and we do not find them funny. Humor involves incongruities that are mostly trivial, or even fictional (e.g. fables), so it is not clear how important this error correcting mechanism was to our evolved cognition. Additionally, it is easy to demonstrate that correcting mistaken ideas is not always the basis of humor: people can laugh at the same jokes over and over again; obviously this has nothing to do with learning or correcting previous incorrect perceptions (Greengross & Mankoff, 2012). Greengross and Mankoff (2012) detail further problems for the theory: there are instances where our first perceptions or beliefs are shown to be incorrect where no humor results. A trick question on an exam may elicit an incorrect answer; when we are told that we were wrong, we do not consider it to be funny. Additionally, they note that good humor usually produces laughter. Yet we laugh at many situations that are not on the face of it, humorous: we laugh when we are tickled; children laugh while at play. Humor is also subjective and has a social aspect – consider inside jokes or the fact that different people find different situations to be humorous. Or that something we might not find to be funny when we are alone will cause us to laugh when we are in a group. The theories of humor presented thus far focus on negative aspects of humor, or at best humor as a mechanism to correct mistaken perceptions. What about the positive aspects of humor? Is there any good to be found in it? The theory by Hurley and colleagues (2011) acknowledges that humor is pleasurable – an evolutionary adaptation that makes it possible for us to admit error and revise our perceptions. But humor is more than that – it is desirable, often sharable, surprising, playful, nonsensical, and insightful. During my career, I had the privilege of having an office down the hall from Norman Cousins, who believed that humor was therapeutic. In his book Anatomy of an Illness, Cousins (1979) recounts how he used humor and laughter to regenerate himself from a painful, inflammatory collagen disease. He asked, if negative emotions produce negative chemical changes in the body, then wouldn’t positive emotions produce positive chemical changes? Cousins identified love, hope, faith, laughter, confidence, and the will to live, as having therapeutic value (Cousins, 1979, pp. 34–35). Working with his physician,
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he began implementing a systematic program that included comedy shows and films – Candid Camera, the Marx Brothers – and humor books. He made the discovery that 10 minutes of ‘genuine belly laughter had an anesthetic effect’ that would give him ‘at least two hours of pain-free sleep’ (Cousins, 1979, p. 39). To test his theory, hospital staff took laboratory measures of sedimentation rates immediately after and several hours after each laughter episode, and found that there was a 5-point drop that held and was cumulative (Cousins, 1979, p. 40). Others have pursued this same line of thinking. In 1989, using healthy participants, Berk and colleagues tested the proposal that positive emotional experiences would act as modifiers of neuroendocrine and stress hormones involved in the classical stress response. To detect these changes, the authors studied 10 healthy male participants during a mirthful laughter experience. Five experimental participants viewed a 60-minute humor video and five control participants did not. Serial blood samples were measured for several neuroendocrine and stress hormones. The authors reported that the mirthful laughter experience appeared to reduce serum levels of cortisol, dopac, epinephrine, and growth hormone. They concluded that these biochemical changes have implications for the reversal of the neuroendocrine and classical stress hormone response (Berk et al., 1989). Several reports have demonstrated the use of humor to reduce stress, relieve pain, or as an adjuvant therapy to improve overall quality of life (Cancer Treatment Centers of America, 2013; Christie & Moore, 2005). According to these studies, laughter appears to improve mood, lessen anxiety, reduce psychological measures of stress, and reduce perception of pain. The mechanisms that underlie these effects may involve release of psychological tension, which could act as a buffer of stressful events on affect. However, it is also possible that physiological factors may be involved. For example, laughter can lead to changes in heart rate, skin temperature, blood pressure, pulmonary ventilation, skeletal muscle activity, and brain activity, which may improve overall wellbeing. Psychoneuroimmunology research suggests that, in addition to its established psychological benefits, humor may have physiological effects on immune functioning. Laughter may improve immune function by blocking the production of stress hormones, such as cortisol, and by increasing the release of immune-enhancers, such as beta-endorphin (Cancer Treatment Centers of America, 2013; Christie & Moore, 2005). Nurses have made important contributions to the study of the therapeutic effects of laughter (Christie & Moore, 2005). Bennett, Zeller, Rosenberg, and McCann (2003) have studied the effects of laughter on stress and natural killer (NK) cell activity. In a survey of patients with cancer in the rural Midwest, they noted that humor was one of the most frequently used complementary therapies. To determine the effect of laughter on self-reported stress and NK cell activity, they conducted a randomized, pre-test/post-test comparison group study in a nurse-managed community health clinic in a mid-sized Midwestern city. Participants were 33 healthy adult women. Those in the experimental group viewed a humorous video, while participants in the
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distraction control group viewed a tourism video. Measurements included self-reported stress and arousal (Stress Arousal Check List), mirthful laughter (Humor Response Scale), and immune function (chromium release NK cell cytotoxicity assay). The investigators found that stress decreased significantly for subjects in the humor group, when compared with those in the distraction group (Bennett et al., 2003). The amount of mirthful laughter had a significant correlation with post-intervention stress measures for persons in the humor group. Participants who scored >25 on the humor response scale had a significant increase in immune function post-intervention, and when compared with participants with lower scores. Humor response scale scores correlated with changes in NK cell activity. The investigators concluded that laughter may reduce stress and improve NK cell activity. As low NK cell activity is linked to decreased disease resistance and increased morbidity in persons with cancer and HIV disease, laughter may be a useful cognitive-behavioral intervention (Bennett et al., 2003). Other nurses have investigated the effects of laughter on postprandial blood glucose (Hayashi et al., 2003). These researchers conducted a 2-day experiment with 19 patients with type 2 diabetes not receiving insulin therapy and five healthy subjects. On both experimental days, the participants consumed the same 500 kcal meal. On the first day, they attended a monotonous lecture (40 min) without humorous content. On the second day, they attended a cross-talk Japanese comedy show. The investigators found that patients with diabetes who were exposed to a comedy show demonstrated a significant suppression of the increase in 2-h post-prandial blood glucose, suggesting that laughter ameliorates the post-prandial glucose excursion in the presence of insufficient insulin action (Hayashi et al., 2003). They concluded that this favorable effect of laughter may include the acceleration of glucose utilization by the muscle motion during the comedy show. However, it is possible also that the positive emotions, such as laughter, acted on the neuroendocrine system and suppressed the elevation of blood glucose level (Hayashi et al., 2003). The question in the title of this column asked whether humor should be viewed negatively or positively. In a theoretical sense, it has been proposed to reflect negative emotions such as aggression and superiority, tension release, incongruence, benign violations of norms, and an evolutionary development to correct errors in perception. When we think of why people laugh, many of these explanations gain credence. However, in clinical practice and research, humor used as a means to evoke laughter, has been shown to have therapeutic effects. As noted,
there is a difference between humor and laughter. Many studies describe the laughter of their participants as ‘mirthful,’ meaning joyful or happy, perhaps as distinguished from nervous laughter or demeaning laughter, and so forth. It might be asked what kind of humor was used in the research reported above to elicit laughter. Maybe when introducing humor as a therapy, we should be careful that it is not mean-spirited. Or maybe it does not matter – that laughter itself is the goal. Regardless, there seems to be a promising role for humor and laughter as an adjuvant therapy and one that nurses might be particularly able to employ in their patient care. A final caveat – there is the definite probability that humor is culture-specific and what is funny to one group may not be considered funny by others. Declaration of Interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper. REFERENCES Bennett, M. P., Zeller, J. M., Rosenberg, L., & McCann, J. (2003). The effect of mirthful laughter on stress and Natural Killer cell activity. Alternative Therapies in Health and Medicine, 9(2), 38–45. Berk, L. S., Tan, S. A., Fry, W. F., Napier, B. J., Lee, J. W., Hubbard, R. W., et al. (1989). Neuroendocrine and stress hormone changes during mirthful laughter. American Journal of the Medical Sciences, 298(6), 390– 396. Billig, M. (2002). Freud and the language of humour. The Psychologist, 15(9), 452–456. Cancer Treatment Centers of America. (2013). Laughter therapy. Retrieved from http://www.cancercenter.com/treatments/laughter-therapy/. Christie, W. & Moore, C. (2005). The impact of humor on patients with cancer. Clinical Journal of Oncology Nursing, 9(2), 211–218. Cousins, N. (1979). Anatomy of an illness as perceived by the patient. New York: Bantam Books. Greengross, G. & Mankoff, R. (2012). Inside ‘Inside Jokes’: The hidden side of humor. Evolutionary Psychology, 10(3), 443–456. Hayashi, K., Hayashi, T., Iwanaga, S., Kawai, K., Ishii, H., Shoji, S., et al. (2003). Laughter lowered the increase in postprandial blood glucose. Diabetes Care, 26(5), 1651–1652. Hobbes, T. (1640). Of the passions of the mind. Elements of Law, Natural and Politic, Chapter IX, No. 13, Laughter. Retrieved from http://www.thomashobbes.com/works/elements/10.html. Hurley, M. M., Dennett, D. C., & Adams Jr., R. B. (2011). Inside Jokes: Using Humor to Reverse-Engineer the Mind. Boston: Massachusetts Institute of Technology Press. Meyer, J. C. (2000). Humour as a double-edged sword: Four functions of humour in communication. Communication Theory, 10, 310–331. Smuts, A. (2009). Humor. The Internet Encyclopedia of Philosophy, Retrieved from http://www.iep.utm.edu/. Veatch, T. C. (1998). A theory of humor. Humor – International Journal of Humor Research, 11, 163–215.
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